Iodine Deficiency Disorders After Sixteen Years of Universal Dietary Salt Iodization in a Severe Iodine Deficiency Village in Niger

Introduction: Since 1996, Niger has officially adopted the universal dietary salt iodization program (UDSI). Objective: It is a before‑after trial study conducted to determine the impact of UDSI program in Tiguey 16 years after. Subjects and methods: The study was centered on 371 volunteers whose thyroid gland was palpated and urinary iodine concentration (UIC) determined in 319 of them. Results: The total goitre rate (TGR) was 13.20% with 9.70% invisible but palpable goitre (G1) and 3.50% visible goitre (G2). In 1987, the TGR was 77.15%, with 25.25% G1 and 51.90 % G2. The median UIC was 166.00 μg/L, the 20th percentile 66.40 μg/L and the 80 percentile was 300 μg/L. 68.34 % of the volunteers had a UIC ≥ 100 μg/L, 2.51% <20 μg/L, 10.97% between 20 and 49 μg/L and 18.18% between 50 and 99 μg/L. In 1987, only 3.96% of the studied sample had a UIC ≥ 100 μg/L, 45 % had a UIC <20 μg/L, 35% between 20 and 49 μg/L and 16% from 50 to 99 μg/L. No significant relationship was found between UIC and age and gender or goitre prevalence and gender (P> 0.05). However, goitre prevalence increases significantly with age (p < 0.05). Conclusion: The implementation of the UDSI program in Niger decreased goitre prevalence and significantly improved the nutritional iodine status of the populations of Tiguey. However a slight endemic goitre and mild to moderate iodine deficiency persists.

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Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India

Public Health Nutrition ◽

10.1017/s1368980009990280 ◽

2009 ◽

Vol 13 (3) ◽

pp. 424-429 ◽

Cited By ~ 16

Author(s):

Subhash Yadav ◽

Sushil Kumar Gupta ◽

Madan M Godbole ◽

Manoj Jain ◽

Uttam Singh ◽

...

Keyword(s):

Iodine Deficiency ◽

Urinary Iodine ◽

Vulnerable Groups ◽

Urinary Iodine Concentration ◽

Iodine Deficiency Disorders ◽

Cross Sectional Survey ◽

Iodine Nutrition ◽

Salt Iodization ◽

Goitre Prevalence ◽

The Impact

AbstractObjectiveThe aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India.DesignIn a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content.ResultsA reduction in goitre prevalence was observed from 69 % reported in 1982 to 27·7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5–15 ppm) of iodine from salt.ConclusionsAlthough there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.

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Women Remain at Risk of Iodine Deficiency during Pregnancy: The Importance of Iodine Supplementation before Conception and Throughout Gestation

Nutrients ◽

10.3390/nu11010172 ◽

2019 ◽

Vol 11 (1) ◽

pp. 172 ◽

Cited By ~ 8

Author(s):

Kristen Hynes ◽

Judy Seal ◽

Petr Otahal ◽

Wendy Oddy ◽

John Burgess

Keyword(s):

At Risk ◽

Pregnant Women ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Iodine Concentration ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Supplement Use ◽

Iodine Supplementation ◽

The Impact

In Australia, pregnant women are advised to take an iodine supplement (I-supp) (150 µg/day) to reduce risks to the foetus associated with iodine deficiency (ID). To examine the impact of this recommendation on iodine status, and to identify factors that contribute to adequacy during gestation, supplement use and Urinary Iodine Concentration (UIC) was measured in 255 pregnant women (gestation range 6 to 41 weeks) in Tasmania. The median UIC (MUIC) of 133 µg/L (Inter-quartile range 82–233) was indicative of ID, being below the 150–249 µg/L range for adequacy during pregnancy. Women taking an iodine-containing-supplement (I-supp) had a significantly higher MUIC (155 µg/L) (n = 171) compared to the combined MUIC (112.5 µg/L) (n = 84) of those who had never (120 µg/L) (n = 61) or were no longer taking an I-supp (90 µg/L) (n = 23) (p = 0.017). Among women reporting I-supp use, the MUIC of those commencing the recommended 150 µg/day prior to conception was significantly higher than those starting supplementation following pregnancy confirmation: 196 (98–315) µg/L (n = 45) versus 137.5 (82.5–233.5) µg/L (n = 124), p = 0.032. Despite recommendations for iodine supplementation pregnant Tasmanian women remain at risk of ID. Commencing an I-supp of 150 µg/day prior to conception and continuing throughout pregnancy is required to ensure adequacy. Timely advice regarding the importance of adequate iodine nutrition, including supplementation is needed to reduce the risk of irreversible in utero neurocognitive damage to the foetus.

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Iodine-deficiency disorders in the Aseer region, south-western Saudi Arabia: 20 years after the national survey and universal salt iodization

Public Health Nutrition ◽

10.1017/s1368980014003073 ◽

2015 ◽

Vol 18 (14) ◽

pp. 2523-2529 ◽

Cited By ~ 11

Author(s):

Fuad I Abbag ◽

Saeed A Abu-Eshy ◽

Ahmed A Mahfouz ◽

Suliman A Al-Fifi ◽

Hussein El-Wadie ◽

...

Keyword(s):

Saudi Arabia ◽

Iodine Deficiency ◽

Water Samples ◽

Urinary Iodine ◽

Iodine Content ◽

National Study ◽

Urinary Iodine Concentration ◽

Iodine Deficiency Disorders ◽

Table Salt ◽

Salt Iodization

AbstractObjectiveTo study (i) the current prevalence of iodine-deficiency disorders among schoolchildren in south-western Saudi Arabia after universal salt iodization and (ii) the iodine content of table salts and water.DesignCross-sectional study on a stratified proportional allocation sample of children. Thyroid gland enlargement was assessed clinically and by ultrasound scanning. Urine, table salt and water samples were taken to measure iodine content.SettingsThe Aseer region, south-western Saudi Arabia.SubjectsSchoolchildren aged 8–10 years.ResultsThe study included 3046 schoolchildren. The total goitre rate amounted to 24·0 %. Prevalence of enlarged thyroid by ultrasound was 22·7 %. The median urinary iodine concentration of the study sample amounted to 17·0 µg/l. The iodine content of table salt ranged from 0 to 112 mg/kg; 22·5 % of the table salt samples were below the recommended iodine content (15 mg/kg) set by WHO. The total goitre rate increased significantly from 19·8 % among children using table salt with iodine content ≥15 mg/kg to reach 48·5 % among children using table salt with 0 mg iodine/kg. Analysis of water samples taken from schools showed that the majority of water samples (78·8 %) had an iodine content of 0 µg/l.ConclusionsThe study documented that 18 years after the national study, and after more than a decade of universal salt iodization in Saudi Arabia, the problem of iodine-deficiency disorders is still endemic in the Aseer region. Efforts should focus on fostering advocacy and communication and ensuring the availability of adequately iodized salt.

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Salt Iodization and Urinary Iodine Concentration Levels among Primary School Children in Mt. Elgon Sub-County, Kenya

Asian Food Science Journal ◽

10.9734/afsj/2021/v20i130249 ◽

2021 ◽

pp. 10-17

Author(s):

Stephen N. Onteri ◽

Anselimo O. Makokha ◽

Beatrice Nyanchama Kiage Mokua ◽

Philip Ndemwa

Keyword(s):

Primary School ◽

School Children ◽

Water Samples ◽

Urinary Iodine ◽

Iodine Concentration ◽

Primary School Children ◽

Urinary Iodine Concentration ◽

Iodine Status ◽

Salt Iodization ◽

The Impact

Aims: Iodine plays a key role in thyroid hormone production and functioning. Inadequate iodine intake results in iodine deficiency (ID) which impairs the normal functioning of the thyroid. The deficiency is responsible for damage to brain development, growth retardation, cretinism, and thyroid dysfunction. Millions of people have been condemned to a life of few prospects and continued underdevelopment due to ID. The study was conducted to assess iodine status among primary school children in the Mt. Elgon region and the impact of salt iodization on this status. Study Design: A school-based cross-sectional descriptive study to assess iodine status among primary school children was employed in the study. Study Area and Duration: The study was carried out in Kenya, Bungoma County, Mount Elgon Sub-County. The study period was between 27th November 2018 and 26th November 2019. Methodology: Healthy primary school children aged 6 to 12 years who met the inclusion criteria were included in the study. Spot urine samples were collected in schools, while water samples were collected from different water sources. Salt was collected from households (HH) and at distribution outlets. The Sandell Kolthoff reaction was used to analyse urine and water samples while salt was analysed using iodometric titration. Results: The median urinary iodine concentration (UIC) was 200.7 µg/l. Out of which 0.55% were severely deficient, 5.25% moderately deficient, 18.23% with a mild deficiency, 25.69% had adequate iodine levels, 22.38% had more than adequate, and 27.90% had excess iodine levels. Household and salt samples from different distribution outlets that conformed to set standards of iodization were 49.4% and 63.64%, respectively. Iodine was not detected in all the water samples collected. Conclusion: The study population was found to have adequate iodine based on the median UIC of 200.7 µg/l. However, there was a coexistence of both deficiency and excessive UIC and salt iodization within the population. No iodine was detected in the water samples in the region.

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Iodine Status of Breastfed Infants and their Mothers after Sixteen Years of Universal Dietary Salt Iodization Program in Dosso, Niger

The Open Nutrition Journal ◽

10.2174/1874288220130802002 ◽

2013 ◽

Vol 7 (1) ◽

pp. 7-12 ◽

Cited By ~ 3

Author(s):

Hassimi Sadou ◽

Yaou Moussa ◽

Mousbahou Malam Alma ◽

Hamani Daouda

Keyword(s):

Iodine Deficiency ◽

Educational Level ◽

Urinary Iodine ◽

Urinary Iodine Concentration ◽

Dietary Salt ◽

Term Infants ◽

Feeding Method ◽

Iodine Status ◽

Breastfed Infants ◽

Salt Iodization

Introduction: Universal dietary salt iodization (UDSI) was implemented in Niger in 1996. However, since 2000 there was a slowdown in progress against iodine deficiency. Objective: The objective was to assess iodine nutritional status of infants and their lactating mothers living in Dosso, the state capital of a severe iodine deficiency region in Niger. Methods: The study was centered on 238 full-term infants and their mothers. Some of the data collected were: arm circumference (AC), head circumference (HC) of infant; familial thyroid disease history; the infant feeding method; age of the mother and child; parity, occupation and educational level of the mother. Results: In infants, the urinary iodine concentration (UIC) ranged from 20 to 1600 μg/l with a median of 220 μg/L and 17.23 % had iodine deficiency (UIC<l00μg/L). In mothers, the UIC was within 10 and 820 μg/L with a median of 68 μg/L and 69.75 % had iodine deficiency. No significant statistical correlation was found between infant UIC and their age, type of feeding and gender as well as educational level, occupational group, parity and age of their mothers (p>0.05). Spearman's correlation test indicated weak significant correlation between maternal and infant UIC (r = 0,167, p = 0, 01). Conclusion: Iodine status was suboptimal in 70% of mothers and 17% (mild to moderate) of breastfed infants, thus indicating an urgent need to provide iodine supplement for lactating women in Dosso.

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A Household-Based Survey of Iodine Nutrition in Moroccan Children Shows Iodine Sufficiency at the National Level But Risk of Deficient Intakes in Mountainous Areas

Children ◽

10.3390/children8030240 ◽

2021 ◽

Vol 8 (3) ◽

pp. 240

Author(s):

Laila El Ammari ◽

Naima Saeid ◽

Anouar Talouizte ◽

Hasnae Gamih ◽

Salwa Labzizi ◽

...

Keyword(s):

Iodine Deficiency ◽

Rural Areas ◽

Economic Status ◽

National Level ◽

Urinary Iodine ◽

Iodine Concentration ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Salt Iodization ◽

Moroccan Children

Historically, mountainous areas of Morocco have been affected by endemic goiter and severe iodine deficiency. In 1995, Morocco legislated salt iodization to reduce iodine deficiency. There has been no national survey of iodine nutrition in school-age children for nearly 3 decades. Our aim was to assess iodine nutrition in a national sample of 6–12-year-old children in Morocco to inform the national salt iodization strategy. In this cross-sectional household-based survey, we randomly recruited healthy 6–12-year-old children from 180 clusters in four geographic zones (north and east, central, north and south) covering the 12 regions of Morocco. A questionnaire was completed, including socio-economic status and parental level of education. In addition, anthropometric measurements were taken to assess nutrition status, and a spot urine sample was collected to measure urinary iodine concentration (UIC). A total of 3118 households were surveyed, and 1043 eligible children were recruited, 56% from urban areas and 44% from rural areas. At the national level, the percentage of surveyed samples with UIC < 50 μg/L was 21.6% (19.2%; 24.2%), which exceeds the WHO suggestion of no more than 20% of samples below 50 μg/L, despite an adequate level of median urinary iodine concentration (mUIC) at 117.4 µg/L (110.2; 123.3). There were no statistically significant differences in mUIC comparing urban vs. rural areas and socio-economic status. However, the mUIC was significantly lower in the central (high-altitude non-coastal) zone (p < 0.004), where the mUIC (95% CI) was deficient at 89.2 µg/L (80.8; 102.9). There was also a significant difference in the mUIC by head of household education level (p = 0.008). The mUIC in Moroccan children >100 µg/L indicates iodine sufficiency at the national level. However, the percentage of surveyed samples with UIC < 50 μg/L above suggests that a significant proportion of children remain at risk for iodine deficiency, and it appears those at greatest risk are residing in the central (high altitude non-coastal) zone. A national level mUIC value may conceal discrepancies in iodine intake among different sub-groups, including those defined by geographic region.

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Silent iodine prophylaxis in Western Europe only partly corrects iodine deficiency; the case of Belgium

Acta Endocrinologica ◽

10.1530/eje.0.1430189 ◽

2000 ◽

pp. 189-196 ◽

Cited By ~ 39

Author(s):

F Delange ◽

A Van Onderbergen ◽

W Shabana ◽

E Vandemeulebroucke ◽

F Vertongen ◽

...

Keyword(s):

Iodine Deficiency ◽

Western Europe ◽

Urinary Iodine ◽

Iodine Concentration ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Iodine Prophylaxis ◽

Salt Iodization ◽

Goiter Prevalence ◽

The Status

OBJECTIVE: Belgium is one of the Western European countries in which no program of iodine-deficiency correction using iodized salt has been implemented, in spite of well-documented mild iodine deficiency. In 1995, the median urinary iodine concentration was 55 microg/l (normal: 100-200) and the prevalence of goiter was 11% (normal: below 5%) in representative samples of schoolchildren aged 6-12 years. Based on these results, the authors of the present study and others had emphasized to health professionals and to the public the necessity for iodine supplementation. The objective of this study was to evaluate as to whether these efforts had resulted in an improvement in the status of iodine nutrition. DESIGN: We performed a national survey of the status of iodine nutrition in Belgium based on the determination of thyroid volume, obtained by ultrasonography, and urinary iodine concentrations in schoolchildren. METHODS: A mobile van equipped with an ultrasound instrument, a computer and a deep-freeze visited 23 schools selected from across the country. The sample included 2855 schoolchildren (1365 boys and 1490 girls) aged 6-12 years. RESULTS: The results show a homogeneous situation in the whole country, with a median urinary iodine concentration of 80 microg/l and a goiter prevalence of 5.7%. Urinary iodine slightly decreases with age in girls and reaches a critical value of 59 microg/l at the age of 12 years, together with a goiter prevalence of 18.4%. CONCLUSION: Iodine nutrition has improved slightly in Belgium but mild iodine deficiency continues, with public-health consequences. The improvement indicates silent iodine prophylaxis, as no official salt-iodization measures have been taken. Silent iodine prophylaxis only partly corrects iodine deficiency in Western Europe. Active measures, including the implementation of a program of salt iodization, are urgently required.

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Lack of dietary sources of iodine and the prevalence of iodine deficiency in rural women from Sidama zone, southern Ethiopia

African Journal of Food, Agriculture, Nutrition and Development ◽

10.18697/ajfand.60.12735 ◽

2013 ◽

Vol 13 (60) ◽

pp. 8401-8414

Author(s):

T Gebreegziabher ◽

◽

N Teyike ◽

A Mulugeta ◽

Y Abebe ◽

...

Keyword(s):

Dietary Intake ◽

Iodine Deficiency ◽

Rural Women ◽

Urinary Iodine ◽

Iodine Concentration ◽

Iodized Salt ◽

Southern Ethiopia ◽

Urinary Iodine Concentration ◽

Iodine Deficiency Disorders ◽

Dairy Consumption

Iodine deficiency has been reported to affect a large number of people in Ethiopia. Although significant progress against iodine deficiency disorders (IDD) has been reported worldwide, millions of people remain with insufficient iodine intake. Multiple factors may contribute to iodine deficiency. Hence, the objective of this study was to investigate iodine deficiency and dietary intake of iodine. A cross-sectional survey design was used to assess urinary iodine concentration (UIC), goiter and dietary intake of iodine in a sample of 202 non-pregnant women living in three rural communities of Sidama Zone, southern Ethiopia. Urinary iodine concentration was analyzed using the Sandell-Kolthoff reaction, goiter was assessed using palpation and dietary source of iodine was assessed using a food frequency questionnaire. Data were analyzed using selected descriptive and analytical statistical measures with SAS software. Mean (SD) age, mid upper arm circumference (MUAC) and body mass index [BMI -Wt(kg)/(Ht(m))2] were 30.8(7.9) y, 24.8(2.5) cm and 20 (2.2) respectively. Median UIC was 37.2 µg/L. Participants with UIC <20 µg/L, classified as severely iodine deficient were 22.8%; 46.5% had UIC between 20 to <50 µg/L, classified as moderately iodine deficient, and 27.2 % had UIC in the mild deficiency range of 50 to <100 µg/L. Only 3.5% of the women had UIC ≥ 100 μg/L. The total goiter rate was 15.9%, which was 1.5% visible and 14.4% palpable goiter. A majority of the participants consumed Enset (E. ventricosum), corn and kale frequently and meat was consumed rarely. None of the participants reported ever consuming iodized salt or ever having heard about use of iodized salt. Adjacent communities (Alamura, Tullo and Finchawa) showed significant differences in UIC, goiter rate and frequency of fish and dairy consumption. The findings of the present study revealed that iodine status of the population is a significant public health problem. Hence, there is a need to supply iodized salt in order to achieve the goal of elimination of iodine deficiency disorders in the community.

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Thyroid volumes in a national sample of iodine-sufficient swiss school children: comparison with the World Health Organization/International Council for the control of iodine deficiency disorders normative thyroid volume criteria

Acta Endocrinologica ◽

10.1530/eje.0.1420599 ◽

2000 ◽

pp. 599-603 ◽

Cited By ~ 34

Author(s):

SY Hess ◽

MB Zimmermann

Keyword(s):

Iodine Deficiency ◽

Reference Data ◽

Urinary Iodine ◽

Thyroid Volume ◽

Iodine Concentration ◽

National Sample ◽

World Health ◽

Normative Values ◽

Urinary Iodine Concentration ◽

Iodine Deficiency Disorders

OBJECTIVE: The determination of goiter prevalence in children by thyroid ultrasound is an important tool for assessing iodine deficiency disorders. The current World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) normative values, based on thyroid volume in iodine-sufficient European children, have recently been questioned, as thyroid volumes in iodine-sufficient children from the USA and Malaysia are smaller than the WHO/ICCIDD reference data. Our objective was to describe ultrasonographic thyroid volumes in a representative national sample of iodine-sufficient Swiss school children, and to compare these with the current reference data for thyroid volume. DESIGN AND METHODS: A 3-stage, probability proportionate-to-size cluster sampling method was used to obtain a representative national sample of 600 Swiss children aged 6-12 years. The following data were collected: thyroid size by ultrasound, urinary iodine concentration, weight, height, sex and age. RESULTS: The median urinary iodine concentration (range) of the children was 115 microgram/l (5-413). Application of the WHO/ICCIDD thyroid volume references to the Swiss children resulted in a prevalence of 0%, using either age/sex-specific or body surface area (BSA)/sex-specific cut-off values. Upper limits of normal (97th percentile) of thyroid volume from Swiss children calculated using BSA, sex and age were similar to those reported in iodine-sufficient children in the USA, but were 20-56% lower than the corresponding WHO/ICCIDD references. CONCLUSIONS: Swiss children had smaller thyroids than the European children on which the WHO/ICCIDD references are based, perhaps due to a residual effect of a recent past history of iodine deficiency in many European regions. However, there were sharp differences between our data and a recent set of thyroid volume data in Swiss children produced by the operator and equipment that generated the WHO/ICCIDD reference data. This suggests that interobserver and/or interequipment variability may contribute to the current disagreement on normative values for thyroid size by ultrasound in iodine-sufficient children.

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Clinical practice guidelines “Management of iodine deficiency disorders”

Problems of Endocrinology ◽

10.14341/probl12750 ◽

2021 ◽

Vol 67 (3) ◽

pp. 10-25

Author(s):

F. M. Abdulkhabirova ◽

O. B. Bezlepkina ◽

D. N. Brovin ◽

T. A. Vadina ◽

G. A. Melnichenko ◽

...

Keyword(s):

Clinical Practice ◽

Iodine Deficiency ◽

Clinical Guidelines ◽

Multinodular Goiter ◽

Urinary Iodine ◽

Iodine Concentration ◽

Epidemiological Studies ◽

Urinary Iodine Concentration ◽

Iodine Deficiency Disorders ◽

Adults And Children

Iodine deficiency disorders is a sweeping term that includes structural and functional impairment of the thyroid gland.These clinical guidelines include algorithms for the diagnosis and treatment of euthyroid goiter and nodular/ multinodular goiter in adults and children. In addition, these clinical guidelines contain information on methods for an adequate epidemiological assessment of iodine deficiency disorders using such markers as the percentage of goiter in schoolchildren, the median urinary iodine concentration, the level of neonatal TSH, the median thyroglobulin in children and adults. As well from these clinical guidelines, you can get to know the main methods and groups of epidemiological studies of iodine deficiency disorders.

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